The present invention relates to an apparatus for positioning and securing surgical instruments around an operating table and more particularly to a device for the near automatically securing of surgical instruments in an array evolving with the surgeon's need as the procedure progresses.
Medical technology has progressed to the point where certain internal (within the body cavity) surgical operations are now performed remotely from outside the body cavity. No longer is it necessary to lay open the patient's body, for instance, to remove the patient's gallbladder. Today many of these operations are performed remotely with a telescope (called an endoscope for any optical video instruments looking inside of the body). An endoscope is inserted through a tiny incision and extended into the critical area, thereby allowing a surgeon to view the operation remotely from outside the body with, for example, a television screen. The instruments are inserted into the abdomen or body through tiny surgical incisions. The surgeon can then manipulate the endoscopic instruments from outside the body cavity while watching the procedure on the television screen.
Although the concept of remote endoscopically monitored instrumentation has greatly reduced patient recovery time, the technique is extremely labor intensive and requires a team of highly trained professionals.
With a typical gallbladder operation, four or more such instruments are commonly inserted into a patient's abdomen. A large amount of coordination is required to properly manipulate and position them. One surgeon or trained team member must continually reposition the endoscopic video camera to keep both internal organs and instruments safely and effectively in perspective. Without this coordinated, continually moving support, the surgeon is "blind" and his helpers have no way of coordinating their efforts. Another surgeon, or highly trained medical technician, must hold perfectly still certain of the retractor instruments while the primary surgeon manipulates the "active operating instrument".
In a typical gallbladder operation, one of the instruments is the endo-television camera, a second instrument is either a dissecting laser or electric cautery probe, while the other two instruments are normally retractor devices. Two of the retractor devices are used to grasp and pull the gallbladder aside to a position where the surgeon can reach the "roots" of the gallbladder with the dissector. Traditionally a surgeon or other technician must maintain effective video surveillance while another holds the two retractors securing the gallbladder completely still and the primary surgeon removes the gallbladder with the operating (dissecting) instrument.
Various surgical retaining devices have been developed to hold surgical instruments firmly in some desired attitude or posture. These devices, however, are fairly cumbersome, often project awkwardly into the work area, and are generally not "user friendly" enough to significantly reduce the time and/or number of skilled personnel required to perform present day remote endoscopic surgery. These devices include U.S. Pat. No. 3,572,326 to Jensen and U.S. Pat. No. 4,355,631 to LaVahn. U.S. Pat. Nos. 4,616,632 to Wigoda; 3,858,578 to Milo; and 3,638,973 to Poletti disclose fluid actuated joint means for elements of a retractor.
In an ideal situation, a single surgeon should be able to manipulate and position the array of endoscopic surgical instruments with the aid of fewer highly trained personnel. The obligate new mechanism must be user friendly requiring essentially no continual set up time. It must be low profile and flexible enough to stay out of the way while securing a variety of instruments in the almost fluid evolution or progression of the surgical procedure so that the procedure is faster and safe. This would significantly reduce the size of an operating team and thus, the cost of the operation to the patient. It would significantly reduce the length of time required for such procedures allowing either more extensive surgery in the same time frame or less anesthesia to accomplish the same current goals. Thus the safety to the patient would be dramatically increased.
The present surgical instrument securing devices generally do not achieve these goals.